Reply To 2 Post Diabetes And RA

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Reply to 2 Discussion posts: Diabetes & RA

 

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DISCUSSION POST # 1Reply 1Ashlesha

  • Diabetes Mellitus-II is a metabolic disease that increases the blood sugar level due to abnormal secretion of insulin, insulin resistance to target tissues, and inadequate response to the insulin receptor. (Lynne et al., 2023)

According to Lynne et al. (2023)

  • Family history
  • BMI >25kg/M2
  • Age >45year
  • HBA1C >5.7%
  • History with gestational DM
  • Obesity
  • Sedentary lifestyle
  • Hypertension
  • Hyperlipidemia
  • Female with PCOS
  • Race/Ethnicity (African American, Latino, Native American, Asian American, Pacific Islander)
  • In the pancreas, insulin is secreted by beta cells. Insulin metabolizes and transports glucose in the liver and muscle. (Marianne Belleza, 2020).
  • Insulin and Glucagon maintain the persistent glucose level in the body.(Marianne Belleza, 2020).
  • Diagnosis

According to the American diabetes association,

  • Random Blood Suger>200mg/dl with Other Symptoms
  • Oral glucose Tolerance Test(OGTT) >200MG/DL and higher
  • Fasting Plasma Glucose- >126mg/dl or higher, confirm by checking twice
  • HBA1C >6.5 % or higher

Oral Pharmacology treatment includes diet management, exercise, and weight loss. (Lynne et al., 2023)

  • First-line medication,

Biguanides (e.g., Metformin that can be increased from 500mg to 1500-2000mg/day).

à Second generation:

Sulfonylureas(e.g., Glimepiride) increase insulin in the pancreas naturally.

Alpha-Glucosides inhibitors

Thiazolidinediones

Dipeptidyl Peptide-1nAnalogues

Glucagon-like Peptide-1 Analogues

Sodium-Glucose Transport-2 Inhibitors

Meglitinides

Non-pharmacology management includes Lifestyle modification, Exercise, and weight loss to control blood sugar and prevent further complications.

Every three months, follow up and check HBA1C to control DM-II.

If HBA1C > 7% and poor control, start long actin insulin once at night.

After beginning long actin insulin, still, HBA1C>7%, add rapid actin insulin to control sugar.

Prevention

Screening:

Start at 40 years annually if related risk factors are more frequent.

Women diagnosed with Gestational DM are screened every three years

Eye check-up every year, if related condition, then every six months.

Yearly screening for Kidney functions and Liver functions.

 

DISCUSSION POST #2Regine Marie

 

Rheumatoid arthritis (RA)

 

  • The systemic autoimmune disease rheumatoid arthritis (RA) is characterized by extra-articular involvement and inflammatory arthritis.
  • It is a chronic inflammatory condition that mostly impacts synovial joints and is commonly caused by the interaction of genes with environmental factors, such tobacco.
  • If left untreated, it frequently starts in tiny peripheral joints, progresses to involve proximal joints, and is typically symmetric.Joint degradation with cartilage loss and bone erosion results from joint inflammation over time.
  • The symptoms of early RA are those that have been present for less than six months, while the symptoms of established RA have been present for more than six months.
  • RA is a degenerative illness that worsens mortality and morbidity if untreated.
  • Pathop
  • T- and B-cell infiltration of the synovium and production of inflammatory cytokines by all macrophages.
  • Inflammation will eventually cause tissue to be destroyed.
  • Multiple joints, including those in the hands, wrists, knees, and even feet, will be affected as RA worsens.
  • Many people have stiffness in the morning that lasts for several hours.
  • Symptoms
  • It’s possible for people with RA to experience pain and soreness without initially noticing any redness or swelling in their joints.
  • Following are some indicators of RA: joint discomfort, such as joint pain, soreness, edema, or stiffness, for at least six weeks.
  • Morning stiffness that lasts for at least 30 minutes. A number of joints are affected.
  • The wrists and other minor joints in the hands and feet are frequently the first to feel pain.
  • The same joints on both sides of the body are affected.
  • Extreme fatigue is a common symptom of RA, and some people may even feel feverish.
  • Over time, RA symptoms can alter.
  • Intense inflammation and accompanying symptoms define a flare.
  • There could be days or even months between flares.
  • Eyes: Dryness, pain, swelling, redness, sensitivity to light, and blurred vision.
  • Mouth: Dryness as well as gum inflammation, irritation, or infection.
  • Skin: Rheumatoid nodules are small lumps that form on the bones just beneath the skin.
  • Lungs: Inflammation and scarring that can lead to lung disease and shortness of breath.
  • Vascular inflammation that could affect the skin, nerves, and other organs. Blood vessels.
  • Red blood cells are present in blood in lower amounts than usual.
  • Heart: Inflammation can affect the heart muscle and the surrounding tissues.
  • In addition, stiff joints make it challenging to exercise, which encourages weight gain. Overweight people may be more prone to RA, which raises their risk of high blood pressure, diabetes, heart disease, and high cholesterol.
  • First line treatment
  • NSAIDS:
  • NSAIDs include etodolac (Lodine), naproxen (Naprosyn), ibuprofen (Advil and Motrin), and aspirin (acetylsalicylate).
  • There is a chance of GI, hematologic, and renal damage when using NSAIDS.
  • Opioids:
  • Dextropropoxyphene, codeine, and tramadol are all opioids.
  • Drowsiness, constipation, exhilaration, nausea, vomiting, and respiratory depression are examples of typical adverse effects (Bullock et al. 2019).
  • Corticosteroids
  • Prednisone 2.5–7.5 mg daily) is required for about 50% of RA patients in order to keep their disease under control.
  • Corticosteroids used long-term have been related to a number of toxicities, such as weight gain, osteoporosis, and an elevated risk of infections.
  • Second line treatment
  • The goal is to reduce or stop the disease’s spread.
  • DMARDs, or disease-modifying anti-rheumatic medicines.
  • Methotrexate: Folic acid analog impairs the metabolism of purine and pyrimidine.
  • Liver injury, cirrhosis, immune suppression, and bone loss.
  • Hydroxychloroquine (Plaquenil):
  • Prevents the release of cytokines that result in inflammation and are made by monocytes.
  • Common side effects include toxic effects on the GI tract, skin, eyes, and central nervous system.
  • Sulfasalazine (Azulfidine)
  • The mechanism of Sulfasalazine (Azulfidine) is unknown.
  • Rash, nervous system problems, and gastrointestinal (GI) problems are examples of frequent side effects (Bullock et al. 2019).
  • Treatment and Management
  • Achieving long-term clinical remission and improving quality of life are the major goals of treatment, which also aims to stop the emergence of signs and symptoms of an active inflammatory condition.
  • If clinical remission cannot be achieved, low disease activity is a suitable fallback. A monthly evaluation of the disease activity is recommended for patients with moderate to severe disease activity.
  • Patients with low disease activity or clinical remission should have their disease activity assessed every three to six months.
  • Education
  • Despite the fact that RA has a substantial genetic component and cannot be entirely prevented, modifiable risk factors including smoking and maintaining a balanced diet must be addressed. Advice on how to maintain a healthy weight, engage in regular exercise, and consume a balanced diet should be given to patients who are at risk for developing RA.
  • The value of getting some rest when in pain should be understood by patients and their families.